The present invention relates to a cisplatin formulation for oral administration.
Cisplatin is an anticancer agent known for its effectiveness but also for its significant side effects observed when it is administered intravenously, in particular: nephrotoxicity, gastrointestinal toxicity (nausea, vomiting), neurotoxicity and moderate myelo-suppression.
The nephrotoxicity induced by cisplatin can be alleviated by intravenous saline hydration and by diuresis.
For the last twenty-five years, research has been carried out on cisplatin analogues. Only twelve of these analogues have been evaluated in clinical trials: some have proved to be even more toxic than cisplatin and none has shown an anticancer activity superior to cisplatin.
Researchers have thus turned towards the study of the reduction in toxicity of cisplatin rather than towards that of new analogues.
A first line of research relates to the oral administration of cisplatin in animals.
Studies carried out by Siddik Z. H. et al. and presented at the 74th Congress of the American Cancer Research Association in March 1984 allowed the anticancer activity of cisplatin administered by the oral route in mice affected by plasmacytoma ADJ/PLA to be evaluated. The plasma platinum concentration reached a peak of 4.3 xcexcg/ml after 30-60 minutes for a dose of 50 mg/kg. The bioavailability in the mouse was 31-36% and the incidence of nephrotoxicity was only 20%.
Hasegawa Y. et al. confirm with respect to Muridae, in Chem. Pharm. Bull., 33(12), 5511-5514, 1985, that cisplatin passes into the blood after oral administration and that it is effective under these conditions against solid tumours.
Binks S. P. et al. demonstrate, in Biochemical Society Transactions, 616th Meeting, London, 14, 694 (1986), that the absorption of cisplatin after oral administration is so rapid that the plasma platinum concentration reaches its maximum in less than two hours. The highest levels of platinum are observed in the kidneys.
Analysis with an electron microscope of tissues excised 48 hours after oral administration of cisplatin reveals only slight changes in the kidneys, whereas, for an intravenous administration, symptoms of nephrotoxicity are observable.
Borch R. F. et al. have shown, in Proc. Natl. Acad. Sci., USA, 76, 6611-6614, that urea concentrations in the blood were multiplied by 14 in rats receiving the maximum tolerated dose of cisplatin via the intravenous route and then this result was confirmed by another study by Morgan S. E. et al. (Pharmacology Communication, 1993, Vol. 3, No. 1, 9-18) and shows that administration by the oral route can greatly decrease the nephrotoxicity of cisplatin. No histopathological change in the kidneys was observed in mice treated orally with a toxic dose of cisplatin of 70 mg/kg.
Howell S. B., in Plenum Press, New York. p. 93 (1991), and Harrap K. R. et al., in Adv. Enzyme Regul., 31 (31), 1991, show that the degree of activity of cisplatin administered by the oral route is less than that obtained by the parenteral route and that higher doses are necessary for an oral administration because of the relatively low bioavailability of cisplatin in this case. Consequently, no clinical trial has been carried out on man because the bioavailability of cisplatin administered by the oral route was too low in comparison with conventional intravenous formulations.
A second line of research relates to the combination of low doses of cisplatin with other therapeutic methods.
T. Shirasaka has provided, in Cancer Chemother. Pharmacol., 32, 167-172 (1993) and in Jpn. J. Cancer Chemother., 2/(7), 1025-1028 (1994), a therapy which consists in combining the administration of 5-fluorouracil and low-dose cisplatin. He suggests a therapy of four weeks, which consists in administering a perfusion of 5-fluorouracil in combination with an intravenous dose of 5-6 mg/day of cisplatin.
The anticancer effectiveness of this therapy on the solid tumours of the rodents studied is superior to that of 5-fluorouracil alone or of cisplatin alone and its toxicity is lower.
Many studies carried out in Japan have shown that, with a low-dose regimen, cisplatin in combination with 5-fluorouracil is effective in the treatment of various cancers; moreover, its toxicity is reduced. It is then no longer necessary to resort to hydration by an intravenous route in order to prevent nephrotoxicity.
Moreover, it has been demonstrated, in Chemotherapy, 1996, Vol/Iss/Pg 42/6 (452-458), that low-dose cisplatin can also be combined with S1, an antitumour medicament of oral form which is a tegafur/5-chloro-2,4-dihydroxypyridine/oxonic acid mixture in a 1/0.4/1 molar proportion discovered by T. Shirasaka.
Other combinations of low-dose cisplatin are also possible with other anticancers, such as, but not restricted to, the combination of vinblastine with bleomycin, the combination of etoposide with bleomycin, or alternatively paclitaxel.
In addition, Ducreux M. et al., in Annals of Oncology, 5 (Suppl 8), 81 (1994), have shown that the combination of radiotherapy and of an administration of 4-6 mg/m2/day of cisplatin by the intravenous route for 4-6 weeks improves the anticancer activity and reduces the side effects.
There currently exists no oral cisplatin formulation and the object of the present invention is to provide controlled-release microgranules for oral administration containing cisplatin, the mean particle size of which is between 0.4 and 1.5 mm, in particular between 1 and 1.25 mm.
Controlled release is understood to mean an instantaneous release, a release sustained over time or alternatively a release with targeting of the absorption site, in particular at the ileum where the pH is of the order of 7.
This formulation advantageously provides a bioavailability superior to that of cisplatin of injectable form administered orally and an acceptable gastrointestinal toxicity.
After an intravenous administration, the plasma platinum concentration increases and then decreases rapidly, which leads to significant fluctuations in concentration and causes periods of therapeutic under-and over-concentration responsible for nephrotoxicity and nausea/vomiting.
The controlled-release microgranules formulation according to the invention advantageously makes it possible to release the active principle more evenly and to avoid plasma peaks while maintaining a blood level which is sufficiently high to produce the desired therapeutic effect, without, however, reaching toxic levels which can cause side effects for the patient, because of the extensive distribution of the granules along the digestive tract.
The formulation according to the invention also makes it possible to keep the plasma concentration constant over a longer period of time and to decrease the variations between and within individuals by virtue of a high exchange surface area and avoids the release of a large amount of active principle localized at one point of the digestive mucous membrane.
An advantage of the oral form according to the invention is that it can be used by the patient himself in his home; thus, the patient no longer has to resort to frequent intravenous administrations in a hospital which require professional assistance. Moreover, for hospitalized patients, the oral form according to the invention improves the quality of life by reducing the time spent in hospital and by freeing them from painful treatments, in particular in the case of perfusions at the rate of 100 hours/week.
Each microgranule according to the invention advantageously comprises an immediate microgranule to which is fixed a coating containing a coating agent which makes possible the controlled release of cisplatin and/or of other active principles, the said immediate microgranule being composed either of a mixture of excipients, of cisplatin and optionally of other active principles or of a neutral support grain coated with a mixture of excipients, of cisplatin and optionally of other active is principles.
Immediate microgranule is understood to mean a microgranule, the formulation excipients of which have no significant effect on the rate of release or of diffusion of the active principle.
The coating agent which makes possible the controlled release of cisplatin or optionally of other active principles is preferably composed of one or more pharmaceutically acceptable coating polymers chosen in particular from cellulose polymers or from methacrylic acid copolymers and preferably the poly(ethyl acrylate, methyl methacrylate)s sold under the trade name Eudragit NE 30D(copyright).
The coating containing the coating agent described above is advantageously composed of a single polymer or optionally of a mixture of polymers and/or of a sequence of polymer layers.
Various conventional additives can optionally be combined with the polymer of the coating layer which provides for the controlled release, in particular: a lubricating agent and/or a plasticizing agent and/or a surface-active agent.
The lubricating agent can be composed of a conventional pharmaceutically acceptable lubricant, in particular talc.
The plasticizing agent is preferably composed of a pharmaceutically acceptable plasticizing agent chosen from aliphatic esters, such as esters of citric, phthalic and oxalic acids, and preferably triethyl citrate.
The surfactant can be of anionic, cationic, amphoteric or, preferably, non-ionic type, in particular the polysorbate 80 sold under the trade name Montanox 80(copyright).
A so-called protective coating or prefixing layer can advantageously be applied between the immediate microgranule and the coating containing the coating agent, this inserted layer having the role of isolating the active principle from the polymer used in the coating described above.
The addition of sodium chloride to the mixture of excipients makes it possible to reinforce the stability of the cisplatin active principle. The mixture of excipients thus advantageously comprises sodium chloride.
The microgranules according to the invention advantageously contain a cisplatin content of between 25 and 350 mg/g and preferably between 50 and 60 mg/g.
The present invention also relates to the process for the preparation of the controlled-release microgranules containing cisplatin according to the invention.
The said process consists in fixing cisplatin to neutral support grains by spraying a fixing suspension containing cisplatin in aqueous/alcoholic medium, in alcoholic medium or in aqueous medium.
The fixing suspension is preferably aqueous and contains a stabilizing agent, such as sodium chloride, and one or more binding agents, such as hydroxypropylmethylcellulose or polyethylene glycol. A surface-active agent as described above can optionally be added to the fixing suspension.
The immediate microgranules, once coated with the coating agent which makes possible the controlled release of cisplatin, can be lubricated with talc.
The solvents used in the stages for the preparation of the microgranules of the present invention can be aqueous, alcoholic and/or aqueous/alcoholic in nature. Preferably, water will be used as sole solvent during the manufacturing process.
The microgranules according to the invention can be obtained by extrusion-spheronization by mixing, in a single stage, cisplatin, binding agents and stabilizing agents in aqueous medium.
The microgranules described in the present invention are obtained by use of any equipment appropriate for the preparation and the coating of microgranules well known to a person skilled in the art and in particular equipment of conventional pan, perforated pan, fluidized air bed, extruder and spheronizer type.
Another subject of the present invention is a pharmaceutical preparation containing the controlled-release cisplatin microgranules according to the invention, optionally obtained according to the process described above, in an amount which makes it possible to obtain a unit dose of between 10 and 50 mg of cisplatin.
The said pharmaceutical preparation preferably contains a mixture of controlled-release cisplatin microgranules and of an anticancer agent, for example fluorouracil, S1, the combination of vinblastine with bleomycin, the combination of etoposide with bleomycin, or paclitaxel, as combination product for a use in anticancer therapy which is simultaneous, separate or spread out over time.
Finally, the present invention relates to the use of the microgranules according to the invention in manufacturing a medicament, to be administered by the oral route, intended to be used at low doses, in particular less than or equal to approximately 20 mg/m2/day.
The said medicament can advantageously be used in polychemotherapy and/or in combination with a radiotherapy in order to obtain an average cisplatin blood concentration of between 0.5 and 1.0 xcexcg/ml.